Provider Demographics
NPI:1306892682
Name:TONGUE, ANDREA C (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:C
Last Name:TONGUE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4035 MERCANTILE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-2546
Mailing Address - Country:US
Mailing Address - Phone:503-635-4436
Mailing Address - Fax:503-635-7356
Practice Address - Street 1:4035 MERCANTILE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2546
Practice Address - Country:US
Practice Address - Phone:503-635-4436
Practice Address - Fax:503-635-7356
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD07840207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR196949Medicaid
ORC91189Medicare UPIN